Common sporting illnesses and injuries

Chapter Seven Common sporting illnesses and injuries



Learning outcomes


Demonstrate care and management of athletes suffering from sporting-related injuries and illnesses.



1. Define and apply the RICER and NO HARM principles.


2. Recognise and manage athletes with hard and soft tissue injuries.


3. Recognise and manage head and spinal injuries.


4. Recognise and manage trunk injuries.


5. Recognise and manage upper limb injuries.


6. Recognise and manage lower limb injuries.


7. Recognise and manage heat and cold injuries and illness.


8. Recognise and manage signs and symptoms of shock.


9. Recognise and manage serious bleeding.


10. Apply wound management principles appropriate to sport.




Assessment of outcomes



Underpinning knowledge


Oral or written questions may be asked relating to the principles and practices of injury and illness management in a sporting context. You may also be asked to complete an online learning task related to principles of injury management and submit copies of completed online tasks.



Practical demonstration


You may be asked to show treatment of your athletes or manage medical documentation. You may be required to identify specific sporting injuries and use sports medicine equipment in the treatment of these injuries.



Scenario


You may be asked to perform one or more treatments for a range of sports-related injuries. You may also be asked to complete all necessary documents and complete a handover to other medical personnel.



Introduction


This chapter examines the management of some of the more common injuries and medical conditions that can occur in sport, particularly those that are more serious and that require rapid, correct care. This assumes competence in first aid and builds on the competencies in the Apply First Aid course but with a sports focus.


Due to the nature and demands of sport and exercise, the human body can sustain a range of injuries or be exposed to certain types of medical conditions. Although the possibility of sports-related injuries and medical conditions represents an ongoing risk to participants, this must be contrasted with the proven health benefits of sport and physical activity, especially compared to health conditions and illnesses that are likely to occur with inactivity or sedentary behaviour. These health benefits include improvement in nearly all aspects of human health, including cardiovascular, skeletal and muscular health as well as psychological and emotional wellbeing.



Shock


Shock is a term used to describe the loss of effective circulation. As a result of inadequate circulation the oxygen supplied to the body’s tissues is less than required for normal function. This can lead to the shutdown and death of body tissues, including vital organs such as the brain, lungs and heart. Urgent medical attention is necessary in all cases of shock or suspected shock to prevent the risk of serious permanent tissue damage or the death of the affected person.



Causes of shock


Shock can occur in conjunction with any injury or medical condition but is most commonly associated with:



image blood loss as a result of external or internal bleeding


image burns


image fluid loss from severe diarrhoea, vomiting, sweating or dehydration


image cardiac emergencies


image brain or spinal cord injury


image severe infections


image allergic reactions


image major or multiple fractures


image major trauma.



Signs of shock




image Reduced level of consciousness


image Rapid, weak pulse


image Rapid breathing


image Vomiting


image Pale, cold or clammy skin


All these signs usually appear within the first hour of an injury.



Symptoms of shock




image Faintness or dizziness


image Trembling or weakness in the arms and legs


image Enlarged (dilated) pupils


image Nausea


image Restlessness or anxiety


image Confusion



Management of shock


For athletes with severe injuries, illness or infection, shock should be anticipated as early intervention and appropriate care may prevent shock from developing. Management of shock includes:



image If any signs or symptoms of shock are present, seek medical help urgently.


image If the athlete is apparently unresponsive, commence the DRSABCD principles.


image Lay the athlete on their back in a horizontal position to maintain circulation to the trunk. Do not elevate the head.


image If a head or spinal injury is not suspected, raise the athlete’s legs but keep the head level with the heart.


image Loosen any tight clothing or protective equipment.


image Protect the athlete from extremes of temperature.


image Moisten the athlete’s lips, but do not give drinks or food.


image Continue to monitor the athlete closely as they may deteriorate rapidly.



Serious bleeding


The standard procedure for treating an athlete with serious life-threatening bleeding is:



image Treat the athlete for shock.


image Send for medical help.


image Apply and maintain direct pressure to control bleeding. Pressure is applied using gloved fingers or the heel of the hand in conjunction with sterile or clean compress pads, bandages or towels.


image If bleeding is heavy or a dressing is not available, grasp the sides of the wound and press them firmly together.


image If bleeding persists, do not remove the dressing. Apply further pads and bandaging.


image In the case of bleeding from a limb, elevate the injured part while supporting any suspected fracture.


image Do not try to clean major bleeding as stopping the bleeding using direct pressure is critical.


image Apply oxygen therapy when it is available and qualified personnel are present.


image Arterial tourniquets are not recommended.



Hard tissue injuries


Hard tissue injuries are injuries that affect the bones and include fractures of actual bones as well as dislocations and subluxations of the joints between bones. If in doubt as to whether a fracture or dislocation is present, a hard tissue injury should be treated as a fracture.



Fractures


A fracture is an injury where bone tissue loses its normal structure, usually as a result of direct or indirect trauma. There are many different types of fractures; they can be classified according to the type of damage to the bone (e.g.complete/incomplete, displaced/undisplaced) as well as whether the fractured bone penetrates the skin and causes an open wound (open fracture/closed fracture – see Figure 7.1). Fractures can also be classified according to the cause, such as stress fractures, which commonly occur in sport because of overuse or biomechanical problems the athlete might have.


image

Figure 7.1 Fractures of the tibia


Both open and closed fractures have the potential to cause serious injury to internal body structures. Although many fractures are not immediately life threatening, fractures can cause shock and major internal and external bleeding.


Fractures usually present with:



image the occurrence of a forceful episode


image falling


image being hit by an object or opponent


image possible deformity or swelling


image localised tenderness, and/or a deep aching pain.



Signs of a fracture




image Deformity – the affected part is changed in shape


image Bone protruding from an open wound


image Localised swelling


image Movement in a limb occurring other than at a joint


image Loss of normal movement or function


image Signs of shock



Symptoms of a fracture




image Pain and tenderness at the site


image The sound of a snap or pop at the time of injury


image Feeling/sound of bone ends grating


image Tingling or numbness


image Symptoms of shock



Management of fractures


Acute management of fractures depends on the location of the injury and the type of fracture; however, for the purposes of providing immediate treatment, the following steps apply to most fractures.



image Follow DRSABCD principles as appropriate.


image If the athlete is conscious, reassure them and advise them not to move.


image Call for an ambulance or medical assistance.


image Control bleeding if there is an open wound and cover it with a sterile dressing to reduce infection.


image Check that circulation is present distal to the fracture. If not, call for urgent medical aid.


image If the athlete needs to be moved, immobilise the area of the suspected fracture first.


image Immobilise the injured limb in the position you found it.


image Be sure to immobilise the area above and below the fracture.


image If the fracture needs to be splinted, the splint must be long enough to extend past the joints above and below the fracture site as well as wide enough to support the fracture site.


image Check the athlete for other injuries and treat appropriately.


image Apply ice packs or cold compresses, if possible, for up to 20 minutes if pain permits. Reapply ice every 2 hours if necessary. Do not apply ice to open fractures.


image Assess for shock and treat as required.


image

Figure 7.2 Splinting a suspected fracture



Management of skull fractures


Skull fractures may be characterised by:



image watery blood from the nose or ears


image swelling or a bump on the skull


image depression in the skull


image bleeding from the scalp.


Management of skull fractures includes the following steps:



image Rest and prevent the athlete from sustaining possible further harm.


image Reassure the athlete.


image Place the athlete in a position of comfort if possible.


image Suspect spinal injury and treat accordingly.


image

Figure 7.3 Skull fracture



Management of upper and lower arm fractures




image Control bleeding if there is an open wound and cover it with a sterile dressing to reduce infection. Apply padding around any protruding bones.


image For lower arm fractures, apply a splint from the elbow to the hand to immobilise the fracture. Support the fracture using a broad arm sling.


image If the suspected fracture involves the elbow or is very close to it, do not move the elbow. Support and immobilise the arm in the position you found it.


image For upper arm fractures, place a pad between the arm and the chest and apply an elevated arm sling to immobilise the arm.


image Check that circulation is present beyond the fracture. If not, call for urgent medical aid.


image Check the athlete for other injuries and treat appropriately.


image

Figure 7.4 Splint and sling for a suspected lower arm fracture


image

Figure 7.5 Checking for circulation



Management of upper and lower leg fractures




image Control bleeding if there is an open wound and cover it with a sterile dressing to reduce infection. Apply padding around protruding bones.


image The uninjured leg may be used as a splint for upper and lower leg fractures. Place a pad or splinting material between the legs, bring the uninjured leg to the injured leg and tie the legs together with bandages above and below the suspected fracture. Tie off on the uninjured side.


image If the ground is supporting the limb adequately there may be no need to splint it to the other limb.


image Check that circulation is present beyond the fracture. If not, call for urgent medical aid.


image Check the athlete for other injuries and treat appropriately.


image

Figure 7.6 Splinting for a suspected lower limb fracture



Management of hip fractures




image Control bleeding if there is an open wound and cover it with a sterile dressing to prevent infection. Apply padding around protruding bones.


image The uninjured leg may be used as a splint for hip fractures. Place a pad between the legs, bring the uninjured leg to the injured leg and tie the legs together with triangular bandages above and below the fracture, at the knees and at the ankles/feet. Tie off on the uninjured side.


image Do not move the athlete unless they are in life-threatening danger. If they must be moved, immobilise them on a spinal board or similar hard surface.


image Check for signs of circulation distal to the fracture site.


image Monitor vital signs and treat for shock.



Management of pelvic fractures




image Control bleeding if there is an open wound and cover it with a sterile dressing to prevent infection. Apply padding around protruding bones.


image Place the legs and feet in a position of comfort.


image Discourage the athlete from urinating.


image Monitor vital signs and treat for shock.


image Do not move the athlete unless they are in life-threatening danger. If they must be moved, immobilise them on a spinal board or similar hard surface.



Management of rib fractures




image Ensure the athlete is in a comfortable position. If possible, allow them to find their own position of comfort. A half-sitting position resting the affected side on a pillow or cushion is ideal.


image Encourage shallow breathing to reduce pain.


image Apply padding over the affected ribs.


image Place the arm that is on the same side as the injury over the pad.


image Secure the pad with broad bandages over the arm and around the body, tying them off on the non-injured side.


image Immobilise the arm using an appropriate sling.


image Seek medical assistance.


image Be aware that breathing difficulties may be associated with rib fractures.


image

Figure 7.7 Immobilising a suspected rib fracture



Hard tissue injuries in young athletes


The principles of injury assessment and management of fractures in children and young people are the same as for adults. However, it is important to be aware of possible fractures or dislocations in younger athletes as fractures may occur through the growth plate region (epiphysis) of the bone. Incorrectly treated fractures of the growth plate can cause an interruption in the growth of the bone, which can lead to permanent disabilities.



Dislocations


A dislocation is an injury in which a bone is moved out of its normal position within a joint with another bone. The most common examples in sport are dislocations of the fingers and the shoulder joint. Dislocations often cause considerable pain and muscle spasm. They also can cause damage to the joint capsule and surrounding ligaments and may affect surrounding nerves and muscles. It is often difficult for a sports trainer to tell the difference between a dislocation and a fracture or even a joint sprain. If in doubt, treatment should be given as though for a suspected fracture. Dislocations may also be associated with fractures of bones in or near the affected joint so, for all dislocations, a follow-up X-ray should be arranged. This is true whether or not the dislocated joint has been relocated to its usual position.



Signs of a dislocation




image Loss of function


image Swelling at the site


image Deformity



Symptoms of a dislocation




image Pain and tenderness at the site of the injury



Management of a dislocation




image Do not attempt to reposition the dislocated joint.


image Prevent movement occurring at the site of the dislocation to reduce the risk of further tissue damage.


image Immobilise the injured limb in the position you found it.


image Gently apply a splint and sling. Be sure to immobilise the area above and below the injured joint.


image Check for signs of circulation below the dislocation.


image If possible, apply ice packs or cold compresses for up to 20 minutes at a time to relieve pain. Reapply if necessary.


image Treat for shock where appropriate.


image

Figure 7.8 Right anterior shoulder dislocation demonstrating loss of normal shoulder contour


image

Figure 7.9 Dislocation of an interphalangeal joint of the finger



Rules for managing dislocations




image Remember that the sports trainer should not attempt to relocate or reduce the dislocation of any joint.


image For all dislocations a referral for follow-up medical assessment is essential.


image A follow-up X-ray should be arranged for all dislocations to check for associated fractures.


image Do not give the athlete anything to eat or drink.



Subluxation


Subluxations are incomplete dislocations. As with dislocations, subluxations may cause damage to the joint capsule and surrounding ligaments. Treat as for a dislocation.



Soft tissue injuries


Soft tissue injuries involve tissues other than bone. With respect to musculoskeletal injuries, they include sprains of ligament tissue and strains of muscle tissue. If there is doubt about the severity of the injury and whether it involves soft or hard tissue, treat it as a fracture.


Soft tissue includes:



image Muscle – muscles consist of cells with a specific function, namely to contract to produce movement of the body. They are usually attached to bones by tendons. Muscles have an extensive blood supply and consequently may bleed heavily when injured. The common injuries that occur to muscle tissue are strains and contusions/bruises.


image Tendons – tendons are tough bands of slightly elastic connective tissue that connect muscle to bone. Tendons relay the force the muscle produces to the bones to cause movement. Common injuries to tendons include strains or complete tears (rupture) and inflammation or degeneration of the tendon (tendinopathy).


image Ligaments – ligaments are strong bands of fibrous tissue that attach to adjacent bones in joints. They enhance the stability of the joint. An injured ligament is called a sprain.


image The joint capsule – this is the thin ligamentous tissue that surrounds joints and produces the lubricating synovial fluid found in joints. These tissues can also be injured with a joint strain, dislocation or subluxation.


image Skin and fatty tissue – an injury to any of these tissues is classified as a soft tissue injury.


Organs such as the brain, lungs or kidneys, although soft in nature, are not included in the definition of soft tissues.


Some soft tissue injuries may have a clear history of a particular cause or incident, whereas for others this will be unclear. Regardless of the cause, all soft tissue injuries can be managed using the RICER and NO HARM principles that are discussed later in this chapter.



Strains


A strain is a soft tissue injury involving muscle tissue and is usually caused by overstretching of the muscle. Strains vary from minor to major depending on the amount of muscle tissue that is damaged. A full-thickness tear of a muscle is often referred to as a complete muscle rupture; these ruptures may require surgical repair.



Signs of a strain




image Swelling


image Possible discolouration and bruising


image Loss of muscle strength



Symptoms of a strain




image Pain on movement, especially where it involves resisted muscle contractions or stretching of the injured muscle



Sprains


Sprains occur when the ligaments that connect bones within a joint are forcibly stretched beyond their normal range, leading to stretching or tearing. Sprains vary from minor to major depending on the amount of ligament tissue that is damaged. A full-thickness tear of a ligament is often referred to as a complete ligament rupture; these usually require prolonged immobilisation or surgery to repair or reattach the separated ends of the ligament.



Signs and symptoms of a sprain




image Swelling


image Possible bruising or discolouration


image Pain on joint movement



Contusions


A contusion or bruise is a soft tissue injury affecting muscle tissue and blood vessels that bleed into the muscle. Contusions are usually caused by blunt trauma to the area. They usually respond well to RICER treatment. Gentle exercise or movement can usually be started within a few hours after the injury.



Signs of a contusion




image Swelling


image Discolouration



Symptoms of a contusion




image Pain or tenderness at the site of the injury


image Muscle weakness or inhibition



Process of injury and repair in soft tissue injuries


As soft tissue injuries are the most prevalent injuries encountered in athletes it is useful for a sports trainer to have an understanding of the injury and repair process. A sports trainer will frequently have to explain this process to injured athletes in order to ensure adherence to the correct management of the injury.


There are eight stages in the process of injury and repair:



1. Initial tissue damage


2. Capillary bleeding


3. Clot formation


4. Tissue swelling


5. Secondary tissue damage


6. Removal of the blood clot and tissue swelling


7. Healing of the tissue


8. Regaining function



Initial tissue damage


When an injury occurs, there will be some degree of initial or primary tissue damage, such as tearing or compression of the tissue. Any subsequent excessive movement may increase the tissue damage and further delay recovery.



Capillary bleeding


Soft tissues have a blood supply to provide them with the constant supply of oxygen and nutrients that are required by them for normal function. When soft tissue is damaged, the capillaries within that tissue are also damaged, resulting in bleeding at the injury site. The degree of capillary bleeding is dependent upon the type of tissue damaged and the extent of the damage. This capillary bleeding may continue for up to 24–72 hours, depending on the severity of the injury, movement after the injury and initial injury care. Some tissues will bleed more than others (e.g. muscle tissue will usually bleed significantly due to its profuse blood supply whereas tendons will bleed less because of their limited blood supply).



Clot formation


The blood lost within the damaged tissue will eventually clot. If the clot is disturbed, such as by movement, the bleeding will continue. The main aim in the management of soft tissue injuries is to restrict tissue damage and minimise capillary bleeding and thereby keep the blood clot to a minimum size.



Secondary tissue damage


Additional or secondary tissue damage may be caused by:



image movement, which may lead to the tearing of more tissue or cause more bleeding damage


image damaged capillaries that continue to bleed, hence causing some cells in the damaged tissue to not receive their required blood supply, thereby leading to further damage


image tissue swelling, which can compress the small blood vessels in the area and reduce circulation to the damaged area.



Inflammation


Inflammation is a normal part of the healing process. Following an injury the inflammatory process occurs, resulting in increases in local tissue temperature, fluid and chemicals that help the body to clear damaged tissue and to initiate the healing process. Inflammation can also be associated with a temporary increase in localised pain.



Healing of tissue


Healing of the damaged tissue commences while the blood clot and associated tissue inflammation or swelling are being removed. Fibrous scar tissue can replace the damaged tissue. This scar tissue can reduce the length and elasticity of damaged tissue. Reducing excessive swelling, guided exercises and gentle stretching of the injured part while the scar tissue is being created can help to retain the tissue length. This increases the flexibility of the damaged tissues and therefore helps to reduce the risk of future injury.



Regaining function


Regaining the function of the injured area begins as the blood clot and tissue swelling are being removed and the new tissue is being laid down. The goal for the athlete and sports trainer is to restore all function to at least the pre-injury condition, not just to alleviate pain. Different rehabilitation routines are used for different injuries. Guidance from a health professional on what sort of rehabilitation strategies and exercises should be used is strongly advised.



Management of soft tissue injuries



RICER principle


RICER is a basic treatment for acute soft tissue injuries and should be used by the sports trainer in the first 48–72 hours of injury. Prompt management of soft tissue injuries using RICER controls swelling immediately after the injury. RICER aims to minimise bleeding, swelling and further tissue damage. This, in turn, minimises creation of scar tissue in the damaged area, which improves the chance of achieving full recovery and prevents the likelihood of re-injury.


RICER stands for:



image Rest


image Ice


image Compression


image Elevation


image Referral



Rest


Have the injured athlete sit or lie down with the injured part supported carefully to prevent further injury. Do not allow the athlete to move the injured area excessively.


image

Figure 7.10 Rest the injured area in a supported position



Ice


Use ice or a cold pack to cool the affected area. A polythene bag filled with ice pieces and water is ideal. Wrap this in a damp cloth and place it on the injured site. Apply ice packs (covered by a towel or clothing to avoid burning of the skin) or cold compresses for 20 minutes every 2 hours for the first 48–72 hours following an injury.


image

Figure 7.11 Apply ice and elevate the injured area above the heart



Compression


Wrap a compression bandage around the injured area. This will help to support it and reduce movement and swelling at the site of injury. If using an ice pack, apply the compression bandaging over the ice pack or place the ice on top of the compression bandage. Check circulation is present beyond the bandage to ensure it is not too tight and also check the colour, warmth, movement and sensation in the area distal to the compression bandage.


image

Figure 7.12 Applying compression bandaging

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Sep 11, 2016 | Posted by in SPORT MEDICINE | Comments Off on Common sporting illnesses and injuries

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